NR 509 midterm | Questions and Answers |
High Yield Practice Set | Certified Answers
• Aortic valve (heart sounds) -✓✓Right second interspace to the apex
• Pulmonic valve (heart sounds) -✓✓Left second and third interspaces close to the
sternum , but also at higher or lower levels
• Tricuspid Valve (heart sounds) -✓✓At or near the lower left sternal border
• Mitral Valve (heart sounds) -✓✓At and around the cardiac apex
• sinus node -✓✓where normal electrical conduction originates, located in the right
atrium near the junction of the vena cava, cardiac pacemaker.
• Conduction system of the heart -✓✓Sinus node-> AV node-> bundle of his ->
Ventricular myocardium ->Muscular contraction of the atria-> muscular contraction of
the ventricles
• P wave -✓✓atrial depolarization
• QRS -✓✓ventricular depolarization
• Q wave -✓✓downward deflection from septal depolarization
• R wave -✓✓upward deflection from ventricular depolarization
• S wave -✓✓downward deflection following an R wave
• T wave -✓✓ventricular repolarization or recovery
• Cardiac output -✓✓The volume of blood ejected from the left side of the heart in one
minute = HR x stroke volume
• Preload -✓✓the load that stretches the cardiac muscle before contraction, volume of
blood in the RV at the end of diastole
• myocardial contractility -✓✓ability of the cardiac muscle, when given a load, too
shorten. Contractility increases when stimulated by action of the sympathetic nervous
system and decreases when when blood flow or oxygen to myocardium is impaired.
, • after load -✓✓degree of vascular resistance to ventricular contraction include the tone
in the walls of the aorta, large arteries, and the peripheral vascular tree as well as the
volume of blood already in the aorta.
• jugular venous pressure -✓✓reflects right atrial pressure, which in turn equals central
venous pressure and right ventricular end-diastolic pressure.
• JVP estimation -✓✓best estimated from right internal jugular vein, which has the most
direct channel into the right atrium
• cervical systolic murmur or bruit -✓✓May be innocent in children but suspicious for
atherosclerotic disease in adults
• orthopnea and paroxysmal nocturnal dyspnea -✓✓occur in Left ventricular heart failure
and mitral stenosis and in obstructive lung disease
• metabolic syndrome -✓✓A syndrome marked by the presence of usually three or more
of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels,
low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk
of cardiovascular disease and Type 2 diabetes.
• jugular venous pressure -✓✓closely reflects pressure in RA or CVP. Best assessed
from pulsations in Right internal jugular vein which is directly in line with SVC and RA.
JVP falls with loss of blood or decreased venous vascular tone, and increases with right
or left heart failure
• carotid upstroke -✓✓always occurs in systole immediately after S1, sounds or
murmurs heard within the upstroke are systolic. Sounds or murmurs heard following
upstroke are diastolic.
• Carotid bruit -✓✓Turbulent blood flow heard with auscultation over the carotid artery.
(Due to carotid narrowing or plaque)
• point of maximal impulse -✓✓The point on the chest wall over the heart at which the
contraction of the heart is best seen or felt; normally at the fifth intercostal space in the
left midclavicular line in adults
• Splitting of S2 -✓✓Pulmonary valve closure tends to be further delayed during
inspiration, probably because of increased capacity of the pulmonary capillary bed
during inspiration, which prolongs right ventricular ejection. This causes physiologic
splitting of S2, accentuated by inspiration, often best heard near the pulmonary area.
• oscillation point of JVP -✓✓non-palpable, position patent at 45 degrees, look away to
left, look for pulsation in internal jugular vein, differentiate from carotid pulse. Assessed
by looking at right IJV. Use a light diagonally for each heart beat there are 2 pulses for
High Yield Practice Set | Certified Answers
• Aortic valve (heart sounds) -✓✓Right second interspace to the apex
• Pulmonic valve (heart sounds) -✓✓Left second and third interspaces close to the
sternum , but also at higher or lower levels
• Tricuspid Valve (heart sounds) -✓✓At or near the lower left sternal border
• Mitral Valve (heart sounds) -✓✓At and around the cardiac apex
• sinus node -✓✓where normal electrical conduction originates, located in the right
atrium near the junction of the vena cava, cardiac pacemaker.
• Conduction system of the heart -✓✓Sinus node-> AV node-> bundle of his ->
Ventricular myocardium ->Muscular contraction of the atria-> muscular contraction of
the ventricles
• P wave -✓✓atrial depolarization
• QRS -✓✓ventricular depolarization
• Q wave -✓✓downward deflection from septal depolarization
• R wave -✓✓upward deflection from ventricular depolarization
• S wave -✓✓downward deflection following an R wave
• T wave -✓✓ventricular repolarization or recovery
• Cardiac output -✓✓The volume of blood ejected from the left side of the heart in one
minute = HR x stroke volume
• Preload -✓✓the load that stretches the cardiac muscle before contraction, volume of
blood in the RV at the end of diastole
• myocardial contractility -✓✓ability of the cardiac muscle, when given a load, too
shorten. Contractility increases when stimulated by action of the sympathetic nervous
system and decreases when when blood flow or oxygen to myocardium is impaired.
, • after load -✓✓degree of vascular resistance to ventricular contraction include the tone
in the walls of the aorta, large arteries, and the peripheral vascular tree as well as the
volume of blood already in the aorta.
• jugular venous pressure -✓✓reflects right atrial pressure, which in turn equals central
venous pressure and right ventricular end-diastolic pressure.
• JVP estimation -✓✓best estimated from right internal jugular vein, which has the most
direct channel into the right atrium
• cervical systolic murmur or bruit -✓✓May be innocent in children but suspicious for
atherosclerotic disease in adults
• orthopnea and paroxysmal nocturnal dyspnea -✓✓occur in Left ventricular heart failure
and mitral stenosis and in obstructive lung disease
• metabolic syndrome -✓✓A syndrome marked by the presence of usually three or more
of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels,
low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk
of cardiovascular disease and Type 2 diabetes.
• jugular venous pressure -✓✓closely reflects pressure in RA or CVP. Best assessed
from pulsations in Right internal jugular vein which is directly in line with SVC and RA.
JVP falls with loss of blood or decreased venous vascular tone, and increases with right
or left heart failure
• carotid upstroke -✓✓always occurs in systole immediately after S1, sounds or
murmurs heard within the upstroke are systolic. Sounds or murmurs heard following
upstroke are diastolic.
• Carotid bruit -✓✓Turbulent blood flow heard with auscultation over the carotid artery.
(Due to carotid narrowing or plaque)
• point of maximal impulse -✓✓The point on the chest wall over the heart at which the
contraction of the heart is best seen or felt; normally at the fifth intercostal space in the
left midclavicular line in adults
• Splitting of S2 -✓✓Pulmonary valve closure tends to be further delayed during
inspiration, probably because of increased capacity of the pulmonary capillary bed
during inspiration, which prolongs right ventricular ejection. This causes physiologic
splitting of S2, accentuated by inspiration, often best heard near the pulmonary area.
• oscillation point of JVP -✓✓non-palpable, position patent at 45 degrees, look away to
left, look for pulsation in internal jugular vein, differentiate from carotid pulse. Assessed
by looking at right IJV. Use a light diagonally for each heart beat there are 2 pulses for
